Effects of State Laws to Reduce Opioid Diversion on Transitions to Injection Drug Use and HIV/HCV Transmission

减少阿片类药物转移的州法律对注射毒品使用和 HIV/HCV 传播的影响

• 批准号: 10321025
• 负责人: Julia B Dickson-Gomez
• 金额: $ 4.7万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-04-01 至 2022-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10321025
• 关键词: Accident and Emergency department; Admission activity; Affect; Area; Blood; Buprenorphine; Connecticut; County; Data Collection; Data Pooling; Diffusion; Doctor shopping; Drug usage; Emergency treatment; Epidemic; Geographic state; HIV Infections; HIV/HCV; Harm Reduction; Health; Hepatitis; Hepatitis C; Hepatitis C Transmission; Heroin; Heroin Users; Indiana; Infection; Injections; Insurance; Intervention; Kentucky; Laws; Medicaid; Medical; Methadone; Methods; Needle-Exchange Programs; Opiate Addiction; Opioid; Oral; Pain Clinics; Patients; Perception; Pharmaceutical Preparations; Pharmacotherapy; Pharmacy facility; Phase; Physicians; Play; Poisoning; Policies; Prescription opioid overdose; Price; Privatization; Probability; Public Health; Regulation; Reporting; Research; Risk; Role; Rural; Services; Social Network; Sterility; Surveys; Syringes; System; Testing; Vaccination; Water; Wisconsin; Woman; addiction; aged; base; density; design; heroin use; injection drug use; men; metropolitan; opioid injection; opioid misuse; opioid policy; opioid treatment program; opioid use; opioid user; overdose death; prescription monitoring program; prescription opioid; prescription opioid misuse; prevention service; prior authorization; programs; response; rural area; suburb; transmission process; treatment program; urban area; virtual

The purpose of the proposed R01 project entitled “Effects of State Laws to Reduce Opioid Diversion on Transitions to Injection Drug Use and HIV/HCV Transmission” is to examine the effects of state laws designed to reduce opioid diversion and misuse on the transition to injection drug use and HIV/HCV infection. These laws vary in content and implementation by state and include state prescription drug monitoring programs (PDMPs), Medicaid policies that may decrease access to prescription opioids such as prior authorization or pharmacy lock-in programs, Medicaid reimbursement of Medication Assisted therapy, and state regulations of pain clinics. The proposed research will explore the influence of laws in three different states, Connecticut, Kentucky and Wisconsin, selected to represent differences in PDMPs, Medicaid restrictions on opioid prescription, and pain clinic regulation. We will also examine the effects of the local context (drug use networks, syringe availability, harm reduction services, relative price and quality of heroin) on the transition to injecting non-prescription opioids and /or heroin injection in three local areas, an urban area, a smaller metropolitan area or suburb, and a rural town and surrounding county, chosen to reflect areas with higher rates of opioid prescription and opioid overdoses. Specific aims include the following: 1) Identify state laws and policies that have been established to decrease opioid misuse and diversion to establish or refute their association with transition to opioid or heroin injection; 2) Identify how local implementation of state laws and policies may contribute to the transition from nonmedical prescription opioid use to injecting prescription opioids or injecting heroin; 3) Compare local factors in urban, suburban and rural areas that affect the riskiness of injection practices such as the availability of clean syringes, density of drug using networks and accessibility of drug treatment programs. The proposed research will use a two-phase (formative and hypothesis testing) mixed methods design comparing the three states and local areas (3 per state, n=9) to examine factors affecting the relationship between prescription opioid laws and policies and the transition to opioid or heroin injection. .

拟议的题为“州法律对减少阿片类药物转移的影响”的 R01 项目的目的 “注射吸毒和艾滋病毒/丙型肝炎病毒传播的转变”旨在审查州法律设计的效果 减少阿片类药物向注射吸毒过渡和滥用以及艾滋病毒/丙型肝炎病毒感染。 法律的内容和实施因州而异，包括州处方药监测计划 (PDMP)，可能会减少获得处方阿片类药物的医疗补助政策，例如事先授权或 药房锁定计划、药物辅助治疗的医疗补助报销以及州法规 拟议的研究将探讨三个不同州法律的影响：康涅狄格州、 肯塔基州和威斯康星州，被选为代表 PDMP 和医疗补助对阿片类药物的限制方面的差异 我们还将研究当地环境（药物使用）的影响。 网络、注射器可用性、减少危害服务、海洛因的相对价格和质量） 在三个局部地区（一个城市地区、一个较小的地区）注射非处方阿片类药物和/或海洛因注射 选择大都市区或郊区以及乡村城镇和周边县来反映比率较高的地区 阿片类药物处方和阿片类药物过量的具体目标包括： 1) 确定州法律和 为减少阿片类药物滥用和转移而制定的政策，以建立或反驳其 与向阿片类药物或海洛因注射过渡的关联；2) 确定当地如何实施州法律和 政策可能有助于从非医疗处方阿片类药物使用转向注射处方 3）比较城市、郊区和农村地区影响风险的因素； 注射实践的情况，例如清洁注射器的可用性、吸毒网络的密度和可及性 拟议的研究将采用两阶段（形成性检验和假设检验）。 混合方法设计比较三个州和当地地区（每个州 3 个，n=9）以检查因素 影响处方阿片类药物法律和政策与向阿片类药物或海洛因过渡之间的关系 注射。 。